Objective:To evaluate the use of hyperbaric oxygen therapy as an adjunctive treatment in mediastinitis after coronary artery bypass surgery.Methods:This is a retrospective descriptive study, performed between October 2010 and February 2012. Hyperbaric oxygen therapy was indicated in difficult clinical management cases despite antibiotic therapy.Results:We identified 18 patients with mediastinitis during the study period. Thirty three microorganisms were isolated, and polymicrobial infection was present in 11 cases. Enterobacteriaceae were the most prevalent pathogens and six were multi-resistant agents. There was only 1 hospital death, 7 months after the oxygen therapy caused by sepsis, unrelated to hyperbaric oxygen therapy. This treatment was well-tolerated.Conclusion:The initial data showed favorable clinical outcomes.

To determine parameters associated with the evolution of sepsis, a five-year retrospective study was conducted in a university hospital. One hundred and four consecutive sepsis patients were evaluated, of whom 55.8% were men. The mortality was 68.3% and was associated with older age (p<0.05). Chronic comorbidities and infection site were not associated with prognosis. Gram-positive bacteria were more frequently identified in survivors (p<0.05), while non-detection of the germ was associated with mortality (p<0.01). Appropriate use of antibiotics (germ sensitive to at least one drug administered) was associated with survival (p<0.0001) while inappropriate use (p<0.05) or empirical use (p<0.01) were more frequent in nonsurvivors. Leukocytosis was the main abnormality (54.8%) detected on diagnosis, from the leukocyte count. During the evolution, normal leukocyte count was associated with survival (p<0.01) and leukocytosis with mortality (p<0.05). In conclusion, mortality was associated with nondetection of the pathogen, leukocytosis during the evolution of the sepsis and inappropriate or empirical use of antimicrobials. Evidence-based treatment that is directed towards modifiable risk factors might improve the prognosis for sepsis patients.Key-words: Sepsis. Prognosis. Antimicrobials. Risk factors. RESUMOPara determinar parâmetros associados à evolução da sepse, foi realizado estudo retrospectivo de 5 anos em um hospital universitário. Foram avaliados 104 pacientes consecutivos com sepse, sendo 55,8% homens. A mortalidade foi de 68,3%, associada à idade elevada (p<0,05). Doenças crônicas associadas e sítio de infecção não relacionados ao prognóstico. Identificação de bactérias Gram-positivos foi mais frequente em sobreviventes (p<0,05) e não detecção do germe foi associada à mortalidade (p<0,01). O uso apropriado de antibióticos (germe sensível a pelo menos uma droga administrada) foi associado à sobrevida (p<0,0001) enquanto uso inapropriado (p<0,05) ou empírico (p<0,01) foi mais freqüente em não sobreviventes. No diagnóstico, leucocitose foi a principal (54,8%) alteração no leucograma. Na evolução, leucograma normal foi associado à sobrevida (p<0,01) e leucocitose à mortalidade (p<0,05). Em conclusão, a mortalidade foi associada à ausência de detecção do germe, leucocitose na evolução da sepse e uso inapropriado ou empírico de antibióticos. O tratamento baseado em evidências e direcionado para fatores de risco que podem ser modificados deve melhorar o prognóstico do paciente com sepse.Palavras-chaves: Sepse. Prognóstico. Antimicrobianos. Fatores de risco.Fatores de risco.

Syphilis, a disease that in the past was associated with significant morbidity and lethality rates, has resurged in recent years principally as a consequence of changes in risk behavior. An epidemiological group that is commonly affected is the HIV-infected population. The characteristics of the disease and its progression may differ in these patients. The present report describes a case of an HIV-positive male patient, who developed florid secondary syphilis: in addition to syphilitic roseola, he also presented with bilateral panuveitis and involvement of the central nervous system. Investigation revealed the prozone phenomenon and histological examination of the skin lesions showed the presence of leukocytoclastic vasculitis. This finding is extremely rare and few cases have been documented. Keywords: Histology; Syphilis; Syphilis serodiagnosis; HIV; Vasculitis Resumo: A sífilis, doença de importante morbiletalidade no passado, tem ressurgido nos últimos anos, graças, sobretudo, às alterações nos comportamentos de risco. Um grupo epidemiológico, frequentemente, acometido é a população com infecção pelo HIV: estes pacientes podem apresentar características peculiares nas manifestações e evolução da doença. Relatamos o caso de um paciente masculino, HIV-positivo, que desenvolveu um quadro florido de secundarismo: além da roséola sifilítica, apresentou pan-uveíte bilateral e acometimento do sistema nervoso central. A investigação, apresentou fenomeno pro-zona e no estudo histologico, mostrou a presenca de vasculite leucocitoclastica achado este extremamente raro e pouco documentado.

Michel Foucault investigates “the history of the relations that the thought keeps with the truth” and disnaturalizes body, soul and psiqué as historical and discursive inventions, which have meaning only if included into the epistemique arrangements productions of truths, in the case, the emergence of modern thought, specially about human sciences, in general. This research studies the Foucault’s order of the speech on Psychology, in his book “Mental Ilness and Psychology”, with the aim of providing allowances for understanding the history of the speeches of Psychology, about the building of psychological subject and object and its subjectivateurs and contemporaries effects, by questioning the naturalization of conducts considered psychologically abnormal; as well as the application of the same principles of organic pathology to mental pathology, which, together with the postulate of the naturalization of psychological diseases as unitary species, would create the illusion of a real unity between mental and organic pathology, through the complex enunciative imbrication between mind and organism. It was found that for Foucault, the pathology of a certain psychological and individual history should not be reduced to the restricted phenomena of the existence and personalistic perception of the subject, which, inadvertently, could generate a blaming of the subject on the symptoms – organic-mental – inherent to his own conduct, in order to understand the emergence of homo psychologicus as a subject in the cultural and social history of humanity, with special emphasis on the historical production of mental illness figures.

O artigo apresenta a intelectual negra brasileira Virgínia Leone Bicudo, cujo percurso acadêmico e político foi marcado por muitos pioneirismos: (i) foi a única mulher [e negra] a concluir o mestrado na primeira turma de pós-graduação da Escola Livre de Sociologia e Política de São Paulo; (ii) foi a primeira psicanalista não médica no país; (iii) foi precursora nos estudos referentes às relações raciais no Brasil; (iv) foi a única mulher negra a participar nos anos de 1950 do Projeto Unesco, coordenado por Florestan Fernandes e Roger Bastide. Apesar de sua densa trajetória teórica e política com significativas contribuições para o desenvolvimento da Sociologia e da Psicanálise brasileiras, Virgínia Bicudo não ocupa o panteão destinado aos guardiões do pensamento social brasileiro.